chap 18 - disorders of the breast

Question 1

types of tissues in breast

Answer 1

glandular tissues = lobules and ducts
- all women have the same amount of lobules and ducts, around 20-25
stomal supporting tissues
- fat
- fibrous connective tissue

Question 2

abundant blood supply and lymphatic drainage

Answer 2

Most lymph vessels of breast lead to axillary nodes
Drain to these lymph nodes in the armpit
If breast cancer cells reach axillary nodes and continue to grow, nodes swell and cancer more likely to spread to other organs
Will sample lymph from axillary lymph nodes in order to see if breast cancer has metastasized

Question 3

puberty

Answer 3

hyperplasia = increase in cell number
Variations in breast size depend on amount of fat and fibrous tissue rather than glandular tissue
Extremely responsive to hormonal stimulation

Question 4

menstrual cycle

Answer 4

cyclic hyperplasia followed by involution - increase slightly and then gets smaller

Question 5

pregnancy and lactation

Answer 5

hypertrophic glandular ductal tissues - getting ready to nurse the baby, so the glands get larger

Question 6

after menopause

Answer 6

sex hormone levels decline, breasts gradually decrease in size
Both estrogen and progesterone go down

Question 7

most frequent and serious problems

Answer 7

Two main types of breast change
Benign (non-cancerous)
Fibrocystic
Fibroadenoma
Malignant (cancerous)

Question 8

signs, symptoms and tests

Answer 8

galactorrhea
Visual assessment of breast tissue
- Asymmetry - an increase
- Inversion of nipple
- Changes in texture
- Nipple discharge
Palpitation
Gynecomastia
Associated with increased hormone imbalance
Puberty
Medication
Loss of liver function - estrogen is not being broken down efficiently
Bilateral or unilateral
Mammogram

Question 9

mammogram

Answer 9

Most useful for postmenopausal women, whose breasts contain more fat and less glandular tissue than breasts of younger women
Baseline: age 35-40
Annually: age 40 thereafter
Mammogram may identify lesions not detected on physical examination
Fatty tissue: appear dark
Fibrous and glandular tissue: appear as white strands
Cysts and benign tumors: well circumscribed
Malignant tumors
Have irregular borders
Frequently contain flecks of calcium

Question 10

galactorrhea

Answer 10

secretion of milk when you aren’t pregnant

Question 11

MRI

Answer 11

May be better than mammogram for detecting a small carcinoma
Also detects non-significant changes in the breast

Question 12

ultrasound

Answer 12

Can differentiate between solid tissue and fluid filled, benign cysts
Screening modality of choice for young women

Question 13

radiographic/developmental diseases

Answer 13

Embryologically, breasts developed form column of mammary ridges from axilla to upper thighs
Most of the ridges disappear during prenatal development, except for those at the mid thoracic area, giving rise to breasts and nipples
Accessory nipples occasionally develop, surgically removed

Question 14

acute mastitis

Answer 14

Inflammation of the breast
Most commonly due to staph infection
Most common in lactating during first 6 months
Symptoms
Swelling, pain, redness, lumps

Question 15

changes in breast tissue

Answer 15

Fibroadenoma
Fibrocystic changes
Breast cancer

Question 16

fibrocystic breast disease

Answer 16

Most common of benign changes
Etiology
Unknown
More common in ages 20-40
Signs and symptoms
Pain
Lumps in breast
Size changes with menstrual period
Nipple discharge
Can rupture, induce inflammation
Ultrasound examination helpful in distinguishing a cystic from a solid mass
Treatment
Nothing if small cyst
Aspiration of cyst
Surgical excision if no aspiration

Question 17

fibroadenoma

Answer 17

Benign
Well-circumscribed tumor of fibrous and glandular tissue
Is not precancerous
Common in young women
Painless
Size does not fluctuate
Treatment
Surgically excised

Question 18

breast carcinoma

Answer 18

Most frequently diagnosed cancer in american women
Arise from duct-lobular unit
Duct and lobules
Age associated
Leading cause of death from ages 40 to 44
Second most common killer after lung cancer
Types
Familial
Sporadic
Risk factors
Hormonal factors = prolonged estrogen exposure
No children
not breastfeeding
Early menarche
Late menopause
Obesity
Alcohol
Sedentary lifestyle
Caucasian
Hormone replacement therapy
Occurs in both sexes, but rare in men, whose breasts are not subject to stimulation by ovarian hormones

Question 19

familial breast cancer

Answer 19

Mutations in BRCA1 and BRCA2
Genes encode proteins for DNA repair
But only 5-10% of breast cancer
Increased risk for other cancers
Increases cancer risk in males as well

Question 20

development of breast carcinoma

Answer 20

Early stages: too small to be detected by breast exam
Mammogram can identify carcinoma up to 2 years before detection by self breast exam
Cancer continues to grow, initially in situ; eventually become invasive
Metastasizes to axillary lymph nodes and distant sites
Problems with late metastasis - after you were treated initially
Early diagnosis allows prompt treatment and improves the cure rate

Question 21

classification of breast carcinoma

Answer 21

CIS or invasive
CIS = 5 yr survival rate 93%
Invasion = most common at diagnosis
Degree of differentiation of tumor cells
Well-differentiated: cells that resemble normal breast tissue
Poorly-differentiated:
Biopsy of sentinel lymph node - first axillary lymph node

Question 22

carcinoma treatment

Answer 22

Treatment
First modality is surgical excision
Lumpectomy removes cancer and rim of benign tissue for cancers less than 2 cm in diameter that have not spread to lymph nodes
Typically done in smaller with no metastasize
Radiation and chemotherapy are added for more extensive cancer

Question 23

determining individual status of tumor

Answer 23

Presence or absence of hormone receptors
Estrogen receptors and progesterone receptors (PR) - can have one or both
Some cancers use hormones for growth
Positive tumors are associated with favorable prognosis
Anti Estrogenic agents block estrogen signaling and slow the growth of malignant cells in cancers that are ER and or/PR positive
Tamoxifen - slows down the growth, buying the patient more time
Amplification of HER2 (human epidermal growth factor receptor 2) - normal growth factor receptor
HER2 positive tumors more aggressive
HER2+ less responsive to hormone treatment - Like tamoxifen
However, can specifically target treatment for HER2
Triple negative = more difficult to treat
No ER receptor
No PR receptor
No HER2 amplification
No tools except chemotherapy and radiation

Question 24

recurrent metastatic carcinoma

Answer 24

May appear many years after original tumor has been removed
Treatment is to control growth, relieve symptoms, and improve quality of life
Methods of treatment depend on the following factors
Hormone receptor status of tumor
Age of patient
Length that elapsed from initial treatment to appearance of metastasis
Pre- or postmenopausal